Coverage provided and underwritten by Ameritas Life Insurance Corp
Duke employees scheduled to work at least 20 hours per week, can choose from three dental options, depending on the extent of coverage you and your family may need. All options cover Type 1 (preventive), Type 2 (basic), Type 3 (major) and Type 4 (periodontics/endodontics), but differ in how they pay for covered services.
The PPO plan includes a higher maximum annual benefit that Plan A and Plan B, lower negotiated procedure rates and your out of pocket costs are usually lower. However, participants in the PPO should use an in-network provider. If you select the PPO and use an out-of-network provider, the amount the plan pays will be based on discounted network charges and you will be responsible for any charged amount over that allowance. A list of network dentists is available at ameritasgroup.com/group/olbc/duke or by calling Ameritas at 1-800-755-8844. There is also a direct link to the Dental Plan on the Duke Benefits page that can be used to find a network provider.
If you select Plan A, you have the freedom to visit any licensed dentist of your choice. You may also choose to use a network provider. Using a network provider will limit your out of pocket cost. Also if you utilize a network provider, the deductible is waived for all covered procedures.
Plan B provides a very basic benefit and payments are based on a fixed schedule of fees. The schedule for Plan B is available on the Ameritas website at ameritasgroup.com/group/olbc/duke. You should review the fixed schedule before selecting this option.
- Dental Plans Comparison Chart
- 2019 Dental Premiums
- How to Increase Your Annual Maximum Benefit
- Questions to Ask: Making Your Dental Plan Decisions
- Late Entrant Restrictions on Benefits for 2019
Dental plan members having had at least one covered dental service in the prior calendar year and having less than $500 in claims payments will have their annual maximum benefit increased by $250 in the following year. This accumulation can continue each year until the annual maximum has increased on the PPO plan from $1,250 to $2,250; on Plan A from $1,000 to $2,000; and on Plan B from $750 to $1,750. If you reach this annual maximum benefit, the insurance company will not reimburse any additional services for the remainder of the calendar year.
When comparing Duke’s dental plans, it is important to compare out-of-pocket expenses as well as premiums. Here are some questions to ask yourself when choosing a dental plan that matches the needs of you and your family. For specific coverage information, please refer to the Dental Plans Comparison Chart on the following page.
|PPO Plans||Plan A||Plan B|
|Can I visit any dentist?||No, you must use a network dentist||Yes, you may choose any licensed dentist or use a network dentist||No|
|Am I required to use a network dentist?||Yes||No||No|
|If I don't enroll within 30 days after my date of hire or eligibility, and enroll in the future, will I be a "late entrant"?||Yes, please see below for more details||Yes, please see below for more details||Yes, please see below for more details|
|Will my dependent children who live in a different location be covered?||Yes, may choose a dentist within a nationwide network||Yes||Yes|
|Is there a dental deductible before the insurance will pay for covered services?||Yes, an annual $50 deductible for "major" services||Yes, a $100 lifetime deductible for "basic" services and an annual $75 deductible for "major" services||Yes, a combined annual $50 deductible for "basic" and "major" services|
|Will I have out-of-pocket costs for preventive services?||No||Yes, cost sharing may be required if dentist charges above U&C||Yes|
|I need an existing filling replaced. Will it be covered if I enroll in a Duke dental plan?||Yes, if the filling is at least 6 months old||Yes, if the filling is at least 6 months old||Yes, if the filling is at least 6 months old|
|Are teeth whitening services covered under dental coverage?||No||No||No|
If you or a dependent are not currently enrolled for dental coverage through Duke and enroll for 2019, you or the dependent will be considered a "late entrant".
As a "late entrant" your benefits during the first twelve months of coverage will be limited to preventive services: two preventive routine care exams (not including X-rays), two prophylaxis (routine) cleanings, and for children under age 19, one fluoride application. No other dental or orthodontia procedure or services will be covered during the first 12 months, if a member is enrolled as a late entrant.
Periodontal procedures including maintenance would not be covered during this 12 month period.
Once you have been enrolled in a Duke dental insurance plan for at least 12 months, the insurance will also cover basic and major procedures such as fillings, extractions, crowns, root canals and periodontal treatment (including periodontal maintenance which apply toward cleaning frequency).
This 12-month waiting period does not apply:
- if you are switching from one Duke dental plan to another Duke plan.
- if you enroll an eligible dependent within 30 days of a qualifying event such as marriage or adoption.